Provider Demographics
NPI:1952573644
Name:NEUROAXIS NEUROSURGICAL ASSOC P.C.
Entity Type:Organization
Organization Name:NEUROAXIS NEUROSURGICAL ASSOC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:I
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-459-7700
Mailing Address - Street 1:PO BOX 747821
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-7821
Mailing Address - Country:US
Mailing Address - Phone:718-459-7700
Mailing Address - Fax:718-286-1140
Practice Address - Street 1:9525 QUEENS BLVD
Practice Address - Street 2:2ND FLOOR, DEPT. OF NEUROSURGERY
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4511
Practice Address - Country:US
Practice Address - Phone:718-459-7700
Practice Address - Fax:718-286-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160105207T00000X
NY180402207T00000X
NY194649207T00000X
NY202873207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01750081Medicaid
NY01027412Medicaid
NY02061503Medicaid
NY01514929Medicaid
NY02061503Medicaid
NYF79781Medicare UPIN
NYX36484Medicare PIN
NYG58070Medicare UPIN
NY01750081Medicaid
NY01514929Medicaid
NYW30922Medicare PIN
NYH15270Medicare UPIN
NY01027412Medicaid
X36484Medicare PIN
NY96D661Medicare PIN